Embed Size (px)
Citation preview
3/13/2020 Page 1 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
1
MEDICAL
SERVICES 92507 U5 0 20 Years 0.00 $0.0000 $118.56 9/1/2019 0.00 $118.56 P2 9/1/2019
1
MEDICAL
SERVICES 92507 U5 0 20 Years 0.00 $0.0000 $107.78 9/1/2017 0.00 $107.78 0.00 $0.0000 $107.78 9/1/2017 0.00 $107.78 9/1/2019
1
MEDICAL
SERVICES 92507 U5 21 999 Years 0.00 $0.0000 $107.78 9/1/2017 0.00 $107.78 0.00 $0.0000 $107.78 9/1/2017 0.00 $107.78 9/1/2019
1
MEDICAL
SERVICES 92507 UB 0 20 Years 0.00 $0.0000 $86.22 9/1/2019 0.00 $86.22 0.00 $0.0000 $86.22 9/1/2019 0.00 $86.22 9/1/2019
1
MEDICAL
SERVICES 92507 UB 0 20 Years 0.00 $0.0000 $94.85 9/1/2019 0.00 $94.85 P2 9/1/2019
1
MEDICAL
SERVICES 92507 UB 21 999 Years 0.00 $0.0000 $86.22 9/1/2019 0.00 $86.22 0.00 $0.0000 $86.22 9/1/2019 0.00 $86.22 9/1/2019
1
MEDICAL
SERVICES 92508 U5 0 20 Years 0.00 $0.0000 $50.08 9/1/2019 0.00 $50.08 P2 9/1/2019
1
MEDICAL
SERVICES 92508 U5 0 20 Years 0.00 $0.0000 $45.53 9/1/2017 0.00 $45.53 0.00 $0.0000 $45.53 9/1/2017 0.00 $45.53 9/1/2019
Field Descriptions
Indicator denoting that the Fee Schedule row has been added/updated since the last run. 'C' for change; blank for no changes.
Texas Medicaid Fee Schedule Information
HOME HEALTH AGENCYThis fee schedule is intended to be used by a variety of provider types and provider specialties. Some procedure codes might not apply to every provider type and provider specialty designated to use the fee schedule. For detailed benefits and limitations, providers should refer to the current year’s Texas Medicaid Provider
Procedures Manual and relevant issues of the Texas Medicaid Bulletin.
Change Ind:
TOS:
TOS Desc:
Last Pricing Review
Date:
Adjusted Fee for Report
Date:
Note Codes:
Proc Code:
Mod 1:
Frm:
Client Age
Thru:
Mod 2:
Change
Ind
One-character type-of-service (TOS) code assigned to each procedure code for system administration.
Description of the TOS.
The five-digit code for services and items defined in Current Procedure Terminology or the Healthcare Common Procedure Coding System.
1st Modifier, if required for pricing determination.
2nd Modifier, if required for pricing determination.
The “from age” is the beginning of an age range, if it is required for determining pricing. Some procedure codes have more than one pricing row. If the first row has a 0-999 age range, and the second row has a 21-999 age range, then the client age range for the first row (0-999) is actually 0-20
years of age. If the first row has a 0-999 age range and the second row has a 0-20 age range, then the client age range for the first row (0-999) is actually 21-999 years of age. Refer to the Texas Medicaid Provider Procedures Manual (TMPPM) for the exact age limitations.
The “through age” is the end of an age range, if it is required for determining pricing. Some procedure codes have more than one pricing row. If the first row has a 0-999 age range, and the second row has a 21-999 age range, then the client age range for the first row (0-999) is actually 0-20 years
of age. If the first row has a 0-999 age range and the second row has a 0-20 age range, then the client age range for the first row (0-999) is actually 21-999 years of age. Refer to the TMPPM for exact age limitations.
Medicaid rates are based on the client’s age in days, months or years.
Non-Facility pricing is for services that are rendered in places of service other than an inpatient hospital or an outpatient hospital. Facility pricing is for services that are rendered in an inpatient hospital (place of service [POS] 3), or an outpatient hospital or ambulatory surgical center (POS 5).
The current relative value units (RVUs) for the procedure code, if the fee is a resource-based fee (RBF). The payable amount for RBFs is calculated by multiplying the total RVUs by the applicable conversion factor. For Anesthesia services only, this column shows the base units instead; and
payment is based on the sum of the base units plus actual face-to-face time units multiplied by the applicable conversion factor.
The Texas Medicaid conversion factor that is applicable for determining the amount payable when the rate is calculated by base units for anesthesia services or RVUs for other services.
The Medicaid allowed amount.
Note code indicator. Providers should review each note code to identify specific payment explanation or limitation. See Note Codes worksheet for applicable payment explanation or limitation.
Adjust %:
Total RVUs/Base Units:
Non-facility/Facility
Fee Effect Date:
Medicaid Fee:
Conversion Factor:
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
Client Age Units:
The effective date of service for which the fee is payable.
A percentage reduction has been applied to the allowed fee for this service. This column shows the percent by which the fee was adjusted. Additional information about rate changes is available on the TMHP website at www.tmhp.com/pages/topics/rates.aspx.
A percentage reduction has been applied to the allowed fee for this service. This column does not show reductions that may have been applied using other criteria that include but are not limited to place of service, client type program, or provider specialty. Additional information about rate changes
is available on the TMHP website at www.tmhp.com.
Medicaid rates are reviewed every two years or as necessary. This column shows the date on which the most recent review was conducted.
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 2 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
1
MEDICAL
SERVICES 92508 U5 21 999 Years 0.00 $0.0000 $45.53 9/1/2017 0.00 $45.53 0.00 $0.0000 $45.53 9/1/2017 0.00 $45.53 9/1/2019
1
MEDICAL
SERVICES 92508 UB 0 20 Years 0.00 $0.0000 $36.42 9/1/2019 0.00 $36.42 0.00 $0.0000 $36.42 9/1/2019 0.00 $36.42 9/1/2019
1
MEDICAL
SERVICES 92508 UB 0 20 Years 0.00 $0.0000 $40.06 9/1/2019 0.00 $40.06 P2 9/1/2019
1
MEDICAL
SERVICES 92508 UB 21 999 Years 0.00 $0.0000 $36.42 9/1/2019 0.00 $36.42 0.00 $0.0000 $36.42 9/1/2019 0.00 $36.42 9/1/2019
1
MEDICAL
SERVICES 92521 0 20 Years 0.00 $0.0000 $111.23 9/1/2019 0.00 $111.23 P2 0.00 $0.0000 $101.12 9/1/2017 0.00 $101.12 9/1/2019
1
MEDICAL
SERVICES 92521 0 20 Years 0.00 $0.0000 $101.12 9/1/2017 0.00 $101.12 9/1/2019
1
MEDICAL
SERVICES 92521 21 999 Years 0.00 $0.0000 $101.12 9/1/2017 0.00 $101.12 0.00 $0.0000 $101.12 9/1/2017 0.00 $101.12 9/1/2019
1
MEDICAL
SERVICES 92522 0 20 Years 0.00 $0.0000 $140.10 9/1/2019 0.00 $140.10 P2 0.00 $0.0000 $127.36 9/1/2017 0.00 $127.36 9/1/2019
1
MEDICAL
SERVICES 92522 0 20 Years 0.00 $0.0000 $127.36 9/1/2017 0.00 $127.36 9/1/2019
1
MEDICAL
SERVICES 92522 21 999 Years 0.00 $0.0000 $127.36 9/1/2017 0.00 $127.36 0.00 $0.0000 $127.36 9/1/2017 0.00 $127.36 9/1/2019
1
MEDICAL
SERVICES 92523 0 20 Years 0.00 $0.0000 $186.79 9/1/2019 0.00 $186.79 P2 0.00 $0.0000 $169.81 9/1/2017 0.00 $169.81 9/1/2019
1
MEDICAL
SERVICES 92523 0 20 Years 0.00 $0.0000 $169.81 9/1/2017 0.00 $169.81 9/1/2019
1
MEDICAL
SERVICES 92523 21 999 Years 0.00 $0.0000 $169.81 9/1/2017 0.00 $169.81 0.00 $0.0000 $169.81 9/1/2017 0.00 $169.81 9/1/2019
1
MEDICAL
SERVICES 92524 0 20 Years 0.00 $0.0000 $95.50 9/1/2019 0.00 $95.50 P2 0.00 $0.0000 $86.82 9/1/2017 0.00 $86.82 9/1/2019
1
MEDICAL
SERVICES 92524 0 20 Years 0.00 $0.0000 $86.82 9/1/2017 0.00 $86.82 9/1/2019
1
MEDICAL
SERVICES 92524 21 999 Years 0.00 $0.0000 $86.82 9/1/2017 0.00 $86.82 0.00 $0.0000 $86.82 9/1/2017 0.00 $86.82 9/1/2019
1
MEDICAL
SERVICES 92526 U5 0 20 Years 0.00 $0.0000 $142.27 9/1/2019 0.00 $142.27 P2 9/1/2019
1
MEDICAL
SERVICES 92526 U5 0 20 Years 0.00 $0.0000 $129.34 9/1/2017 0.00 $129.34 0.00 $0.0000 $129.34 9/1/2017 0.00 $129.34 9/1/2019
1
MEDICAL
SERVICES 92526 U5 21 999 Years 0.00 $0.0000 $129.34 9/1/2017 0.00 $129.34 0.00 $0.0000 $129.34 9/1/2017 0.00 $129.34 9/1/2019
1
MEDICAL
SERVICES 92526 UB 0 20 Years 0.00 $0.0000 $103.47 9/1/2019 0.00 $103.47 0.00 $0.0000 $103.47 9/1/2019 0.00 $103.47 9/1/2019
1
MEDICAL
SERVICES 92526 UB 0 20 Years 0.00 $0.0000 $113.82 9/1/2019 0.00 $113.82 P2 9/1/2019
1
MEDICAL
SERVICES 92526 UB 21 999 Years 0.00 $0.0000 $103.47 9/1/2019 0.00 $103.47 0.00 $0.0000 $103.47 9/1/2019 0.00 $103.47 9/1/2019
1
MEDICAL
SERVICES 92610 0 20 Years 0.00 $0.0000 $225.63 9/1/2019 0.00 $225.63 P2 0.00 $0.0000 $205.12 9/1/2017 0.00 $205.12 9/1/2019
1
MEDICAL
SERVICES 92610 0 20 Years 0.00 $0.0000 $205.12 9/1/2017 0.00 $205.12 9/1/2019
1
MEDICAL
SERVICES 92610 0 999 Years 0.00 $0.0000 $205.12 9/1/2017 0.00 $205.12 0.00 $0.0000 $205.12 9/1/2017 0.00 $205.12 9/1/2019
1
MEDICAL
SERVICES 97012 AT U5 0 20 Years 0.00 $0.0000 $18.16 9/1/2019 0.00 $18.16 P2 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 3 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
1
MEDICAL
SERVICES 97012 AT U5 0 20 Years 0.00 $0.0000 $16.51 9/1/2017 0.00 $16.51 9/1/2019
1
MEDICAL
SERVICES 97012 AT U5 21 999 Years 0.00 $0.0000 $16.51 9/1/2017 0.00 $16.51 0.00 $0.0000 $16.51 9/1/2017 0.00 $16.51 9/1/2019
1
MEDICAL
SERVICES 97012 AT UB 0 20 Years 0.00 $0.0000 $14.53 9/1/2019 0.00 $14.53 P2 0.00 $0.0000 $13.21 9/1/2019 0.00 $13.21 9/1/2019
1
MEDICAL
SERVICES 97012 AT UB 21 999 Years 0.00 $0.0000 $13.21 9/1/2019 0.00 $13.21 0.00 $0.0000 $13.21 9/1/2019 0.00 $13.21 9/1/2019
1
MEDICAL
SERVICES 97012 U5 0 20 Years 0.00 $0.0000 $18.16 9/1/2019 0.00 $18.16 P2 9/1/2019
1
MEDICAL
SERVICES 97012 U5 0 20 Years 0.00 $0.0000 $16.51 9/1/2017 0.00 $16.51 0.00 $0.0000 $16.51 9/1/2017 0.00 $16.51 9/1/2019
1
MEDICAL
SERVICES 97012 U5 21 999 Years 0.00 $0.0000 $16.51 9/1/2017 0.00 $16.51 0.00 $0.0000 $16.51 9/1/2017 0.00 $16.51 9/1/2019
1
MEDICAL
SERVICES 97012 UB 0 20 Years 0.00 $0.0000 $13.21 9/1/2019 0.00 $13.21 0.00 $0.0000 $13.21 9/1/2019 0.00 $13.21 9/1/2019
1
MEDICAL
SERVICES 97012 UB 0 20 Years 0.00 $0.0000 $14.53 9/1/2019 0.00 $14.53 P2 9/1/2019
1
MEDICAL
SERVICES 97012 UB 21 999 Years 0.00 $0.0000 $13.21 9/1/2019 0.00 $13.21 0.00 $0.0000 $13.21 9/1/2019 0.00 $13.21 9/1/2019
C
HOME HEALTH
PROCEDURE 97012 U5 0 20 Years 0.00 $0.0000 $18.16 9/1/2019 0.00 $18.16 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97012 U5 0 20 Years 0.00 $0.0000 $16.51 9/1/2017 0.00 $16.51 9/1/2019
C
HOME HEALTH
PROCEDURE 97012 U5 21 999 Years 0.00 $0.0000 $16.51 9/1/2017 0.00 $16.51 9/1/2019
C
HOME HEALTH
PROCEDURE 97012 UB 0 20 Years 0.00 $0.0000 $14.53 9/1/2019 0.00 $14.53 P2 0.00 $0.0000 $13.21 9/1/2019 0.00 $13.21 9/1/2019
C
HOME HEALTH
PROCEDURE 97012 UB 21 999 Years 0.00 $0.0000 $13.21 9/1/2019 0.00 $13.21 9/1/2019
1
MEDICAL
SERVICES 97014 AT U5 0 20 Years 0.00 $0.0000 $17.77 9/1/2019 0.00 $17.77 P2 9/1/2019
1
MEDICAL
SERVICES 97014 AT U5 0 20 Years 0.00 $0.0000 $16.15 9/1/2017 0.00 $16.15 9/1/2019
1
MEDICAL
SERVICES 97014 AT U5 21 999 Years 0.00 $0.0000 $16.15 9/1/2017 0.00 $16.15 0.00 $0.0000 $16.15 9/1/2017 0.00 $16.15 9/1/2019
1
MEDICAL
SERVICES 97014 AT UB 0 20 Years 0.00 $0.0000 $14.22 9/1/2019 0.00 $14.22 P2 0.00 $0.0000 $12.92 9/1/2019 0.00 $12.92 9/1/2019
1
MEDICAL
SERVICES 97014 AT UB 21 999 Years 0.00 $0.0000 $12.92 9/1/2019 0.00 $12.92 0.00 $0.0000 $12.92 9/1/2019 0.00 $12.92 9/1/2019
1
MEDICAL
SERVICES 97014 U5 0 20 Years 0.00 $0.0000 $17.77 9/1/2019 0.00 $17.77 P2 9/1/2019
1
MEDICAL
SERVICES 97014 U5 0 20 Years 0.00 $0.0000 $16.15 9/1/2017 0.00 $16.15 0.00 $0.0000 $16.15 9/1/2017 0.00 $16.15 9/1/2019
1
MEDICAL
SERVICES 97014 U5 21 999 Years 0.00 $0.0000 $16.15 9/1/2017 0.00 $16.15 0.00 $0.0000 $16.15 9/1/2017 0.00 $16.15 9/1/2019
1
MEDICAL
SERVICES 97014 UB 0 20 Years 0.00 $0.0000 $12.92 9/1/2019 0.00 $12.92 0.00 $0.0000 $12.92 9/1/2019 0.00 $12.92 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 4 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
1
MEDICAL
SERVICES 97014 UB 0 20 Years 0.00 $0.0000 $14.22 9/1/2019 0.00 $14.22 P2 9/1/2019
1
MEDICAL
SERVICES 97014 UB 21 999 Years 0.00 $0.0000 $12.92 9/1/2019 0.00 $12.92 0.00 $0.0000 $12.92 9/1/2019 0.00 $12.92 9/1/2019
C
HOME HEALTH
PROCEDURE 97014 U5 0 20 Years 0.00 $0.0000 $17.77 9/1/2019 0.00 $17.77 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97014 U5 0 20 Years 0.00 $0.0000 $16.15 9/1/2017 0.00 $16.15 9/1/2019
C
HOME HEALTH
PROCEDURE 97014 U5 21 999 Years 0.00 $0.0000 $16.15 9/1/2017 0.00 $16.15 9/1/2019
C
HOME HEALTH
PROCEDURE 97014 UB 0 20 Years 0.00 $0.0000 $14.22 9/1/2019 0.00 $14.22 P2 0.00 $0.0000 $12.92 9/1/2019 0.00 $12.92 9/1/2019
C
HOME HEALTH
PROCEDURE 97014 UB 21 999 Years 0.00 $0.0000 $12.92 9/1/2019 0.00 $12.92 9/1/2019
1
MEDICAL
SERVICES 97016 AT U5 0 20 Years 0.00 $0.0000 $21.71 9/1/2019 0.00 $21.71 P2 9/1/2019
1
MEDICAL
SERVICES 97016 AT U5 0 20 Years 0.00 $0.0000 $19.74 9/1/2017 0.00 $19.74 9/1/2019
1
MEDICAL
SERVICES 97016 AT U5 21 999 Years 0.00 $0.0000 $19.74 9/1/2017 0.00 $19.74 0.00 $0.0000 $19.74 9/1/2017 0.00 $19.74 9/1/2019
1
MEDICAL
SERVICES 97016 AT UB 0 20 Years 0.00 $0.0000 $17.37 9/1/2019 0.00 $17.37 P2 0.00 $0.0000 $15.79 9/1/2019 0.00 $15.79 9/1/2019
1
MEDICAL
SERVICES 97016 AT UB 21 999 Years 0.00 $0.0000 $15.79 9/1/2019 0.00 $15.79 0.00 $0.0000 $15.79 9/1/2019 0.00 $15.79 9/1/2019
1
MEDICAL
SERVICES 97016 U5 0 20 Years 0.00 $0.0000 $21.71 9/1/2019 0.00 $21.71 P2 9/1/2019
1
MEDICAL
SERVICES 97016 U5 0 20 Years 0.00 $0.0000 $19.74 9/1/2017 0.00 $19.74 0.00 $0.0000 $19.74 9/1/2017 0.00 $19.74 9/1/2019
1
MEDICAL
SERVICES 97016 U5 21 999 Years 0.00 $0.0000 $19.74 9/1/2017 0.00 $19.74 0.00 $0.0000 $19.74 9/1/2017 0.00 $19.74 9/1/2019
1
MEDICAL
SERVICES 97016 UB 0 20 Years 0.00 $0.0000 $15.79 9/1/2019 0.00 $15.79 0.00 $0.0000 $15.79 9/1/2019 0.00 $15.79 9/1/2019
1
MEDICAL
SERVICES 97016 UB 0 20 Years 0.00 $0.0000 $17.37 9/1/2019 0.00 $17.37 P2 9/1/2019
1
MEDICAL
SERVICES 97016 UB 21 999 Years 0.00 $0.0000 $15.79 9/1/2019 0.00 $15.79 0.00 $0.0000 $15.79 9/1/2019 0.00 $15.79 9/1/2019
C
HOME HEALTH
PROCEDURE 97016 U5 0 20 Years 0.00 $0.0000 $21.71 9/1/2019 0.00 $21.71 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97016 U5 0 20 Years 0.00 $0.0000 $19.74 9/1/2017 0.00 $19.74 9/1/2019
C
HOME HEALTH
PROCEDURE 97016 U5 21 999 Years 0.00 $0.0000 $19.74 9/1/2017 0.00 $19.74 9/1/2019
C
HOME HEALTH
PROCEDURE 97016 UB 0 20 Years 0.00 $0.0000 $17.37 9/1/2019 0.00 $17.37 P2 0.00 $0.0000 $15.79 9/1/2019 0.00 $15.79 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 5 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
C
HOME HEALTH
PROCEDURE 97016 UB 21 999 Years 0.00 $0.0000 $15.79 9/1/2019 0.00 $15.79 9/1/2019
1
MEDICAL
SERVICES 97018 AT U5 0 20 Years 0.00 $0.0000 $12.24 9/1/2019 0.00 $12.24 P2 9/1/2019
1
MEDICAL
SERVICES 97018 AT U5 0 20 Years 0.00 $0.0000 $11.13 9/1/2017 0.00 $11.13 9/1/2019
1
MEDICAL
SERVICES 97018 AT U5 21 999 Years 0.00 $0.0000 $11.13 9/1/2017 0.00 $11.13 0.00 $0.0000 $11.13 9/1/2017 0.00 $11.13 9/1/2019
1
MEDICAL
SERVICES 97018 AT UB 0 20 Years 0.00 $0.0000 $9.79 9/1/2019 0.00 $9.79 P2 0.00 $0.0000 $8.90 9/1/2019 0.00 $8.90 9/1/2019
1
MEDICAL
SERVICES 97018 AT UB 21 999 Years 0.00 $0.0000 $8.90 9/1/2019 0.00 $8.90 0.00 $0.0000 $8.90 9/1/2019 0.00 $8.90 9/1/2019
1
MEDICAL
SERVICES 97018 U5 0 20 Years 0.00 $0.0000 $12.24 9/1/2019 0.00 $12.24 P2 9/1/2019
1
MEDICAL
SERVICES 97018 U5 0 20 Years 0.00 $0.0000 $11.13 9/1/2017 0.00 $11.13 0.00 $0.0000 $11.13 9/1/2017 0.00 $11.13 9/1/2019
1
MEDICAL
SERVICES 97018 U5 21 999 Years 0.00 $0.0000 $11.13 9/1/2017 0.00 $11.13 0.00 $0.0000 $11.13 9/1/2017 0.00 $11.13 9/1/2019
1
MEDICAL
SERVICES 97018 UB 0 20 Years 0.00 $0.0000 $8.90 9/1/2019 0.00 $8.90 0.00 $0.0000 $8.90 9/1/2019 0.00 $8.90 9/1/2019
1
MEDICAL
SERVICES 97018 UB 0 20 Years 0.00 $0.0000 $9.79 9/1/2019 0.00 $9.79 P2 9/1/2019
1
MEDICAL
SERVICES 97018 UB 21 999 Years 0.00 $0.0000 $8.90 9/1/2019 0.00 $8.90 0.00 $0.0000 $8.90 9/1/2019 0.00 $8.90 9/1/2019
C
HOME HEALTH
PROCEDURE 97018 U5 0 20 Years 0.00 $0.0000 $12.24 9/1/2019 0.00 $12.24 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97018 U5 0 20 Years 0.00 $0.0000 $11.13 9/1/2017 0.00 $11.13 9/1/2019
C
HOME HEALTH
PROCEDURE 97018 U5 21 999 Years 0.00 $0.0000 $11.13 9/1/2017 0.00 $11.13 9/1/2019
C
HOME HEALTH
PROCEDURE 97018 UB 0 20 Years 0.00 $0.0000 $9.79 9/1/2019 0.00 $9.79 P2 0.00 $0.0000 $8.90 9/1/2019 0.00 $8.90 9/1/2019
C
HOME HEALTH
PROCEDURE 97018 UB 21 999 Years 0.00 $0.0000 $8.90 9/1/2019 0.00 $8.90 9/1/2019
1
MEDICAL
SERVICES 97022 AT U5 0 20 Years 0.00 $0.0000 $26.46 9/1/2019 0.00 $26.46 P2 9/1/2019
1
MEDICAL
SERVICES 97022 AT U5 0 20 Years 0.00 $0.0000 $24.05 9/1/2017 0.00 $24.05 9/1/2019
1
MEDICAL
SERVICES 97022 AT U5 21 999 Years 0.00 $0.0000 $24.05 9/1/2017 0.00 $24.05 0.00 $0.0000 $24.05 9/1/2017 0.00 $24.05 9/1/2019
1
MEDICAL
SERVICES 97022 AT UB 0 20 Years 0.00 $0.0000 $21.17 9/1/2019 0.00 $21.17 P2 0.00 $0.0000 $19.24 9/1/2019 0.00 $19.24 9/1/2019
1
MEDICAL
SERVICES 97022 AT UB 21 999 Years 0.00 $0.0000 $19.24 9/1/2019 0.00 $19.24 0.00 $0.0000 $19.24 9/1/2019 0.00 $19.24 9/1/2019
1
MEDICAL
SERVICES 97022 U5 0 20 Years 0.00 $0.0000 $26.46 9/1/2019 0.00 $26.46 P2 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 6 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
1
MEDICAL
SERVICES 97022 U5 0 20 Years 0.00 $0.0000 $24.05 9/1/2017 0.00 $24.05 0.00 $0.0000 $24.05 9/1/2017 0.00 $24.05 9/1/2019
1
MEDICAL
SERVICES 97022 U5 21 999 Years 0.00 $0.0000 $24.05 9/1/2017 0.00 $24.05 0.00 $0.0000 $24.05 9/1/2017 0.00 $24.05 9/1/2019
1
MEDICAL
SERVICES 97022 UB 0 20 Years 0.00 $0.0000 $19.24 9/1/2019 0.00 $19.24 0.00 $0.0000 $19.24 9/1/2019 0.00 $19.24 9/1/2019
1
MEDICAL
SERVICES 97022 UB 0 20 Years 0.00 $0.0000 $21.17 9/1/2019 0.00 $21.17 P2 9/1/2019
1
MEDICAL
SERVICES 97022 UB 21 999 Years 0.00 $0.0000 $19.24 9/1/2019 0.00 $19.24 0.00 $0.0000 $19.24 9/1/2019 0.00 $19.24 9/1/2019
C
HOME HEALTH
PROCEDURE 97022 U5 0 20 Years 0.00 $0.0000 $26.46 9/1/2019 0.00 $26.46 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97022 U5 0 20 Years 0.00 $0.0000 $24.05 9/1/2017 0.00 $24.05 9/1/2019
C
HOME HEALTH
PROCEDURE 97022 U5 21 999 Years 0.00 $0.0000 $24.05 9/1/2017 0.00 $24.05 9/1/2019
C
HOME HEALTH
PROCEDURE 97022 UB 0 20 Years 0.00 $0.0000 $21.17 9/1/2019 0.00 $21.17 P2 0.00 $0.0000 $19.24 9/1/2019 0.00 $19.24 9/1/2019
C
HOME HEALTH
PROCEDURE 97022 UB 21 999 Years 0.00 $0.0000 $19.24 9/1/2019 0.00 $19.24 9/1/2019
1
MEDICAL
SERVICES 97024 AT U5 0 20 Years 0.00 $0.0000 $7.50 9/1/2019 0.00 $7.50 P2 9/1/2019
1
MEDICAL
SERVICES 97024 AT U5 0 20 Years 0.00 $0.0000 $6.82 9/1/2017 0.00 $6.82 9/1/2019
1
MEDICAL
SERVICES 97024 AT U5 21 999 Years 0.00 $0.0000 $6.82 9/1/2017 0.00 $6.82 0.00 $0.0000 $6.82 9/1/2017 0.00 $6.82 9/1/2019
1
MEDICAL
SERVICES 97024 AT UB 0 20 Years 0.00 $0.0000 $6.00 9/1/2019 0.00 $6.00 P2 0.00 $0.0000 $5.46 9/1/2019 0.00 $5.46 9/1/2019
1
MEDICAL
SERVICES 97024 AT UB 21 999 Years 0.00 $0.0000 $5.46 9/1/2019 0.00 $5.46 0.00 $0.0000 $5.46 9/1/2019 0.00 $5.46 9/1/2019
1
MEDICAL
SERVICES 97024 U5 0 20 Years 0.00 $0.0000 $7.50 9/1/2019 0.00 $7.50 P2 9/1/2019
1
MEDICAL
SERVICES 97024 U5 0 20 Years 0.00 $0.0000 $6.82 9/1/2017 0.00 $6.82 0.00 $0.0000 $6.82 9/1/2017 0.00 $6.82 9/1/2019
1
MEDICAL
SERVICES 97024 U5 21 999 Years 0.00 $0.0000 $6.82 9/1/2017 0.00 $6.82 0.00 $0.0000 $6.82 9/1/2017 0.00 $6.82 9/1/2019
1
MEDICAL
SERVICES 97024 UB 0 20 Years 0.00 $0.0000 $5.46 9/1/2019 0.00 $5.46 0.00 $0.0000 $5.46 9/1/2019 0.00 $5.46 9/1/2019
1
MEDICAL
SERVICES 97024 UB 0 20 Years 0.00 $0.0000 $6.00 9/1/2019 0.00 $6.00 P2 9/1/2019
1
MEDICAL
SERVICES 97024 UB 21 999 Years 0.00 $0.0000 $5.46 9/1/2019 0.00 $5.46 0.00 $0.0000 $5.46 9/1/2019 0.00 $5.46 9/1/2019
C
HOME HEALTH
PROCEDURE 97024 U5 0 20 Years 0.00 $0.0000 $7.50 9/1/2019 0.00 $7.50 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97024 U5 0 20 Years 0.00 $0.0000 $6.82 9/1/2017 0.00 $6.82 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 7 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
C
HOME HEALTH
PROCEDURE 97024 U5 21 999 Years 0.00 $0.0000 $6.82 9/1/2017 0.00 $6.82 9/1/2019
C
HOME HEALTH
PROCEDURE 97024 UB 0 20 Years 0.00 $0.0000 $6.00 9/1/2019 0.00 $6.00 P2 0.00 $0.0000 $5.46 9/1/2019 0.00 $5.46 9/1/2019
C
HOME HEALTH
PROCEDURE 97024 UB 21 999 Years 0.00 $0.0000 $5.46 9/1/2019 0.00 $5.46 9/1/2019
1
MEDICAL
SERVICES 97026 AT U5 0 20 Years 0.00 $0.0000 $6.71 9/1/2019 0.00 $6.71 P2 9/1/2019
1
MEDICAL
SERVICES 97026 AT U5 0 20 Years 0.00 $0.0000 $6.10 9/1/2017 0.00 $6.10 9/1/2019
1
MEDICAL
SERVICES 97026 AT U5 21 999 Years 0.00 $0.0000 $6.10 9/1/2017 0.00 $6.10 0.00 $0.0000 $6.10 9/1/2017 0.00 $6.10 9/1/2019
1
MEDICAL
SERVICES 97026 AT UB 0 20 Years 0.00 $0.0000 $5.37 9/1/2019 0.00 $5.37 P2 0.00 $0.0000 $4.88 9/1/2019 0.00 $4.88 9/1/2019
1
MEDICAL
SERVICES 97026 AT UB 21 999 Years 0.00 $0.0000 $4.88 9/1/2019 0.00 $4.88 0.00 $0.0000 $4.88 9/1/2019 0.00 $4.88 9/1/2019
1
MEDICAL
SERVICES 97026 U5 0 20 Years 0.00 $0.0000 $6.71 9/1/2019 0.00 $6.71 P2 9/1/2019
1
MEDICAL
SERVICES 97026 U5 0 20 Years 0.00 $0.0000 $6.10 9/1/2017 0.00 $6.10 0.00 $0.0000 $6.10 9/1/2017 0.00 $6.10 9/1/2019
1
MEDICAL
SERVICES 97026 U5 21 999 Years 0.00 $0.0000 $6.10 9/1/2017 0.00 $6.10 0.00 $0.0000 $6.10 9/1/2017 0.00 $6.10 9/1/2019
1
MEDICAL
SERVICES 97026 UB 0 20 Years 0.00 $0.0000 $4.88 9/1/2019 0.00 $4.88 0.00 $0.0000 $4.88 9/1/2019 0.00 $4.88 9/1/2019
1
MEDICAL
SERVICES 97026 UB 0 20 Years 0.00 $0.0000 $5.37 9/1/2019 0.00 $5.37 P2 9/1/2019
1
MEDICAL
SERVICES 97026 UB 21 999 Years 0.00 $0.0000 $4.88 9/1/2019 0.00 $4.88 0.00 $0.0000 $4.88 9/1/2019 0.00 $4.88 9/1/2019
C
HOME HEALTH
PROCEDURE 97026 U5 0 20 Years 0.00 $0.0000 $6.71 9/1/2019 0.00 $6.71 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97026 U5 0 20 Years 0.00 $0.0000 $6.10 9/1/2017 0.00 $6.10 9/1/2019
C
HOME HEALTH
PROCEDURE 97026 U5 21 999 Years 0.00 $0.0000 $6.10 9/1/2017 0.00 $6.10 9/1/2019
C
HOME HEALTH
PROCEDURE 97026 UB 0 20 Years 0.00 $0.0000 $5.37 9/1/2019 0.00 $5.37 P2 0.00 $0.0000 $4.88 9/1/2019 0.00 $4.88 9/1/2019
C
HOME HEALTH
PROCEDURE 97026 UB 21 999 Years 0.00 $0.0000 $4.88 9/1/2019 0.00 $4.88 9/1/2019
1
MEDICAL
SERVICES 97028 AT U5 0 20 Years 0.00 $0.0000 $8.29 9/1/2019 0.00 $8.29 P2 9/1/2019
1
MEDICAL
SERVICES 97028 AT U5 0 20 Years 0.00 $0.0000 $7.54 9/1/2017 0.00 $7.54 9/1/2019
1
MEDICAL
SERVICES 97028 AT U5 21 999 Years 0.00 $0.0000 $7.54 9/1/2017 0.00 $7.54 0.00 $0.0000 $7.54 9/1/2017 0.00 $7.54 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 8 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
1
MEDICAL
SERVICES 97028 AT UB 0 20 Years 0.00 $0.0000 $6.63 9/1/2019 0.00 $6.63 P2 0.00 $0.0000 $6.03 9/1/2019 0.00 $6.03 9/1/2019
1
MEDICAL
SERVICES 97028 AT UB 21 999 Years 0.00 $0.0000 $6.03 9/1/2019 0.00 $6.03 0.00 $0.0000 $6.03 9/1/2019 0.00 $6.03 9/1/2019
1
MEDICAL
SERVICES 97028 U5 0 20 Years 0.00 $0.0000 $8.29 9/1/2019 0.00 $8.29 P2 9/1/2019
1
MEDICAL
SERVICES 97028 U5 0 20 Years 0.00 $0.0000 $7.54 9/1/2017 0.00 $7.54 0.00 $0.0000 $7.54 9/1/2017 0.00 $7.54 9/1/2019
1
MEDICAL
SERVICES 97028 U5 21 999 Years 0.00 $0.0000 $7.54 9/1/2017 0.00 $7.54 0.00 $0.0000 $7.54 9/1/2017 0.00 $7.54 9/1/2019
1
MEDICAL
SERVICES 97028 UB 0 20 Years 0.00 $0.0000 $6.03 9/1/2019 0.00 $6.03 0.00 $0.0000 $6.03 9/1/2019 0.00 $6.03 9/1/2019
1
MEDICAL
SERVICES 97028 UB 0 20 Years 0.00 $0.0000 $6.63 9/1/2019 0.00 $6.63 P2 9/1/2019
1
MEDICAL
SERVICES 97028 UB 21 999 Years 0.00 $0.0000 $6.03 9/1/2019 0.00 $6.03 0.00 $0.0000 $6.03 9/1/2019 0.00 $6.03 9/1/2019
C
HOME HEALTH
PROCEDURE 97028 U5 0 20 Years 0.00 $0.0000 $8.29 9/1/2019 0.00 $8.29 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97028 U5 0 20 Years 0.00 $0.0000 $7.54 9/1/2017 0.00 $7.54 9/1/2019
C
HOME HEALTH
PROCEDURE 97028 U5 21 999 Years 0.00 $0.0000 $7.54 9/1/2017 0.00 $7.54 9/1/2019
C
HOME HEALTH
PROCEDURE 97028 UB 0 20 Years 0.00 $0.0000 $6.63 9/1/2019 0.00 $6.63 P2 0.00 $0.0000 $6.03 9/1/2019 0.00 $6.03 9/1/2019
C
HOME HEALTH
PROCEDURE 97028 UB 21 999 Years 0.00 $0.0000 $6.03 9/1/2019 0.00 $6.03 9/1/2019
1
MEDICAL
SERVICES 97032 AT U5 0 20 Years 0.00 $0.0000 $40.78 9/1/2019 0.00 $40.78 P2 9/1/2019
1
MEDICAL
SERVICES 97032 AT U5 0 20 Years 0.00 $0.0000 $37.07 9/1/2017 0.00 $37.07 9/1/2019
1
MEDICAL
SERVICES 97032 AT U5 21 999 Years 0.00 $0.0000 $37.07 9/1/2017 0.00 $37.07 0.00 $0.0000 $37.07 9/1/2017 0.00 $37.07 9/1/2019
1
MEDICAL
SERVICES 97032 AT UB 0 20 Years 0.00 $0.0000 $32.62 9/1/2019 0.00 $32.62 P2 0.00 $0.0000 $29.66 9/1/2019 0.00 $29.66 9/1/2019
1
MEDICAL
SERVICES 97032 AT UB 21 999 Years 0.00 $0.0000 $29.66 9/1/2019 0.00 $29.66 0.00 $0.0000 $29.66 9/1/2019 0.00 $29.66 9/1/2019
1
MEDICAL
SERVICES 97032 U5 0 20 Years 0.00 $0.0000 $40.78 9/1/2019 0.00 $40.78 P2 9/1/2019
1
MEDICAL
SERVICES 97032 U5 0 20 Years 0.00 $0.0000 $37.07 9/1/2017 0.00 $37.07 0.00 $0.0000 $37.07 9/1/2017 0.00 $37.07 9/1/2019
1
MEDICAL
SERVICES 97032 U5 21 999 Years 0.00 $0.0000 $37.07 9/1/2017 0.00 $37.07 0.00 $0.0000 $37.07 9/1/2017 0.00 $37.07 9/1/2019
1
MEDICAL
SERVICES 97032 UB 0 20 Years 0.00 $0.0000 $29.66 9/1/2019 0.00 $29.66 0.00 $0.0000 $29.66 9/1/2019 0.00 $29.66 9/1/2019
1
MEDICAL
SERVICES 97032 UB 0 20 Years 0.00 $0.0000 $32.62 9/1/2019 0.00 $32.62 P2 9/1/2019
1
MEDICAL
SERVICES 97032 UB 21 999 Years 0.00 $0.0000 $29.66 9/1/2019 0.00 $29.66 0.00 $0.0000 $29.66 9/1/2019 0.00 $29.66 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 9 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
C
HOME HEALTH
PROCEDURE 97032 U5 0 20 Years 0.00 $0.0000 $40.78 9/1/2019 0.00 $40.78 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97032 U5 0 20 Years 0.00 $0.0000 $37.07 9/1/2017 0.00 $37.07 9/1/2019
C
HOME HEALTH
PROCEDURE 97032 U5 21 999 Years 0.00 $0.0000 $37.07 9/1/2017 0.00 $37.07 9/1/2019
C
HOME HEALTH
PROCEDURE 97032 UB 0 20 Years 0.00 $0.0000 $32.62 9/1/2019 0.00 $32.62 P2 0.00 $0.0000 $29.66 9/1/2019 0.00 $29.66 9/1/2019
C
HOME HEALTH
PROCEDURE 97032 UB 21 999 Years 0.00 $0.0000 $29.66 9/1/2019 0.00 $29.66 9/1/2019
1
MEDICAL
SERVICES 97033 AT U5 0 20 Years 0.00 $0.0000 $38.82 9/1/2019 0.00 $38.82 P2 9/1/2019
1
MEDICAL
SERVICES 97033 AT U5 0 20 Years 0.00 $0.0000 $35.29 9/1/2017 0.00 $35.29 9/1/2019
1
MEDICAL
SERVICES 97033 AT U5 21 999 Years 0.00 $0.0000 $35.29 9/1/2017 0.00 $35.29 0.00 $0.0000 $35.29 9/1/2017 0.00 $35.29 9/1/2019
1
MEDICAL
SERVICES 97033 AT UB 0 20 Years 0.00 $0.0000 $31.06 9/1/2019 0.00 $31.06 P2 0.00 $0.0000 $28.23 9/1/2019 0.00 $28.23 9/1/2019
1
MEDICAL
SERVICES 97033 AT UB 21 999 Years 0.00 $0.0000 $28.23 9/1/2019 0.00 $28.23 0.00 $0.0000 $28.23 9/1/2019 0.00 $28.23 9/1/2019
1
MEDICAL
SERVICES 97033 U5 0 20 Years 0.00 $0.0000 $38.82 9/1/2019 0.00 $38.82 P2 9/1/2019
1
MEDICAL
SERVICES 97033 U5 0 20 Years 0.00 $0.0000 $35.29 9/1/2017 0.00 $35.29 0.00 $0.0000 $35.29 9/1/2017 0.00 $35.29 9/1/2019
1
MEDICAL
SERVICES 97033 U5 21 999 Years 0.00 $0.0000 $35.29 9/1/2017 0.00 $35.29 0.00 $0.0000 $35.29 9/1/2017 0.00 $35.29 9/1/2019
1
MEDICAL
SERVICES 97033 UB 0 20 Years 0.00 $0.0000 $28.23 9/1/2019 0.00 $28.23 0.00 $0.0000 $28.23 9/1/2019 0.00 $28.23 9/1/2019
1
MEDICAL
SERVICES 97033 UB 0 20 Years 0.00 $0.0000 $31.06 9/1/2019 0.00 $31.06 P2 9/1/2019
1
MEDICAL
SERVICES 97033 UB 21 999 Years 0.00 $0.0000 $28.23 9/1/2019 0.00 $28.23 0.00 $0.0000 $28.23 9/1/2019 0.00 $28.23 9/1/2019
C
HOME HEALTH
PROCEDURE 97033 U5 0 20 Years 0.00 $0.0000 $38.82 9/1/2019 0.00 $38.82 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97033 U5 0 20 Years 0.00 $0.0000 $35.29 9/1/2017 0.00 $35.29 9/1/2019
C
HOME HEALTH
PROCEDURE 97033 U5 21 999 Years 0.00 $0.0000 $35.29 9/1/2017 0.00 $35.29 9/1/2019
C
HOME HEALTH
PROCEDURE 97033 UB 0 20 Years 0.00 $0.0000 $31.06 9/1/2019 0.00 $31.06 P2 0.00 $0.0000 $28.23 9/1/2019 0.00 $28.23 9/1/2019
C
HOME HEALTH
PROCEDURE 97033 UB 21 999 Years 0.00 $0.0000 $28.23 9/1/2019 0.00 $28.23 9/1/2019
1
MEDICAL
SERVICES 97034 U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 10 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
1
MEDICAL
SERVICES 97034 U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97034 U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97034 UB 0 20 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97034 UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 9/1/2019
1
MEDICAL
SERVICES 97034 UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97035 AT U5 0 20 Years 0.00 $0.0000 $38.26 9/1/2019 0.00 $38.26 P2 9/1/2019
1
MEDICAL
SERVICES 97035 AT U5 0 20 Years 0.00 $0.0000 $34.78 9/1/2017 0.00 $34.78 9/1/2019
1
MEDICAL
SERVICES 97035 AT U5 21 999 Years 0.00 $0.0000 $34.78 9/1/2017 0.00 $34.78 0.00 $0.0000 $34.78 9/1/2017 0.00 $34.78 9/1/2019
1
MEDICAL
SERVICES 97035 AT UB 0 20 Years 0.00 $0.0000 $30.61 9/1/2019 0.00 $30.61 P2 0.00 $0.0000 $27.82 9/1/2019 0.00 $27.82 9/1/2019
1
MEDICAL
SERVICES 97035 AT UB 21 999 Years 0.00 $0.0000 $27.82 9/1/2019 0.00 $27.82 0.00 $0.0000 $27.82 9/1/2019 0.00 $27.82 9/1/2019
1
MEDICAL
SERVICES 97035 U5 0 20 Years 0.00 $0.0000 $38.26 9/1/2019 0.00 $38.26 P2 9/1/2019
1
MEDICAL
SERVICES 97035 U5 0 20 Years 0.00 $0.0000 $34.78 9/1/2017 0.00 $34.78 0.00 $0.0000 $34.78 9/1/2017 0.00 $34.78 9/1/2019
1
MEDICAL
SERVICES 97035 U5 21 999 Years 0.00 $0.0000 $34.78 9/1/2017 0.00 $34.78 0.00 $0.0000 $34.78 9/1/2017 0.00 $34.78 9/1/2019
1
MEDICAL
SERVICES 97035 UB 0 20 Years 0.00 $0.0000 $27.82 9/1/2019 0.00 $27.82 0.00 $0.0000 $27.82 9/1/2019 0.00 $27.82 9/1/2019
1
MEDICAL
SERVICES 97035 UB 0 20 Years 0.00 $0.0000 $30.61 9/1/2019 0.00 $30.61 P2 9/1/2019
1
MEDICAL
SERVICES 97035 UB 21 999 Years 0.00 $0.0000 $27.82 9/1/2019 0.00 $27.82 0.00 $0.0000 $27.82 9/1/2019 0.00 $27.82 9/1/2019
C
HOME HEALTH
PROCEDURE 97035 U5 0 20 Years 0.00 $0.0000 $38.26 9/1/2019 0.00 $38.26 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97035 U5 0 20 Years 0.00 $0.0000 $34.78 9/1/2017 0.00 $34.78 9/1/2019
C
HOME HEALTH
PROCEDURE 97035 U5 21 999 Years 0.00 $0.0000 $34.78 9/1/2017 0.00 $34.78 9/1/2019
C
HOME HEALTH
PROCEDURE 97035 UB 0 20 Years 0.00 $0.0000 $30.61 9/1/2019 0.00 $30.61 P2 0.00 $0.0000 $27.82 9/1/2019 0.00 $27.82 9/1/2019
C
HOME HEALTH
PROCEDURE 97035 UB 21 999 Years 0.00 $0.0000 $27.82 9/1/2019 0.00 $27.82 9/1/2019
1
MEDICAL
SERVICES 97036 U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97036 U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97036 UB 0 20 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 11 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
1
MEDICAL
SERVICES 97036 UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97110 AT U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
1
MEDICAL
SERVICES 97110 AT U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97110 AT U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97110 AT UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97110 AT UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97110 U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
1
MEDICAL
SERVICES 97110 U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97110 U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97110 UB 0 20 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97110 UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 9/1/2019
1
MEDICAL
SERVICES 97110 UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
C
HOME HEALTH
PROCEDURE 97110 U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97110 U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
C
HOME HEALTH
PROCEDURE 97110 U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
C
HOME HEALTH
PROCEDURE 97110 UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
C
HOME HEALTH
PROCEDURE 97110 UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97112 AT U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
1
MEDICAL
SERVICES 97112 AT U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97112 AT U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97112 AT UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97112 AT UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97112 U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
1
MEDICAL
SERVICES 97112 U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 12 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
1
MEDICAL
SERVICES 97112 U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97112 UB 0 20 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97112 UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 9/1/2019
1
MEDICAL
SERVICES 97112 UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
C
HOME HEALTH
PROCEDURE 97112 U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97112 U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
C
HOME HEALTH
PROCEDURE 97112 U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
C
HOME HEALTH
PROCEDURE 97112 UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
C
HOME HEALTH
PROCEDURE 97112 UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97116 AT U5 0 20 Years 0.00 $0.0000 $34.34 9/1/2019 0.00 $34.34 P2 9/1/2019
1
MEDICAL
SERVICES 97116 AT U5 0 20 Years 0.00 $0.0000 $31.22 9/1/2017 0.00 $31.22 9/1/2019
1
MEDICAL
SERVICES 97116 AT U5 21 999 Years 0.00 $0.0000 $31.22 9/1/2017 0.00 $31.22 0.00 $0.0000 $31.22 9/1/2017 0.00 $31.22 9/1/2019
1
MEDICAL
SERVICES 97116 AT UB 0 20 Years 0.00 $0.0000 $27.47 9/1/2019 0.00 $27.47 P2 0.00 $0.0000 $24.98 9/1/2019 0.00 $24.98 9/1/2019
1
MEDICAL
SERVICES 97116 AT UB 21 999 Years 0.00 $0.0000 $24.98 9/1/2019 0.00 $24.98 0.00 $0.0000 $24.98 9/1/2019 0.00 $24.98 9/1/2019
1
MEDICAL
SERVICES 97116 U5 0 20 Years 0.00 $0.0000 $34.34 9/1/2019 0.00 $34.34 P2 9/1/2019
1
MEDICAL
SERVICES 97116 U5 0 20 Years 0.00 $0.0000 $31.22 9/1/2017 0.00 $31.22 0.00 $0.0000 $31.22 9/1/2017 0.00 $31.22 9/1/2019
1
MEDICAL
SERVICES 97116 U5 21 999 Years 0.00 $0.0000 $31.22 9/1/2017 0.00 $31.22 0.00 $0.0000 $31.22 9/1/2017 0.00 $31.22 9/1/2019
1
MEDICAL
SERVICES 97116 UB 0 20 Years 0.00 $0.0000 $24.98 9/1/2019 0.00 $24.98 0.00 $0.0000 $24.98 9/1/2019 0.00 $24.98 9/1/2019
1
MEDICAL
SERVICES 97116 UB 0 20 Years 0.00 $0.0000 $27.47 9/1/2019 0.00 $27.47 P2 9/1/2019
1
MEDICAL
SERVICES 97116 UB 21 999 Years 0.00 $0.0000 $24.98 9/1/2019 0.00 $24.98 0.00 $0.0000 $24.98 9/1/2019 0.00 $24.98 9/1/2019
C
HOME HEALTH
PROCEDURE 97116 U5 0 20 Years 0.00 $0.0000 $34.34 9/1/2019 0.00 $34.34 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97116 U5 0 20 Years 0.00 $0.0000 $31.22 9/1/2017 0.00 $31.22 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 13 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
C
HOME HEALTH
PROCEDURE 97116 U5 21 999 Years 0.00 $0.0000 $31.22 9/1/2017 0.00 $31.22 9/1/2019
C
HOME HEALTH
PROCEDURE 97116 UB 0 20 Years 0.00 $0.0000 $27.47 9/1/2019 0.00 $27.47 P2 0.00 $0.0000 $24.98 9/1/2019 0.00 $24.98 9/1/2019
C
HOME HEALTH
PROCEDURE 97116 UB 21 999 Years 0.00 $0.0000 $24.98 9/1/2019 0.00 $24.98 9/1/2019
1
MEDICAL
SERVICES 97124 AT U5 0 20 Years 0.00 $0.0000 $30.98 9/1/2019 0.00 $30.98 P2 9/1/2019
1
MEDICAL
SERVICES 97124 AT U5 0 20 Years 0.00 $0.0000 $28.16 9/1/2017 0.00 $28.16 9/1/2019
1
MEDICAL
SERVICES 97124 AT U5 21 999 Years 0.00 $0.0000 $28.16 9/1/2017 0.00 $28.16 0.00 $0.0000 $28.16 9/1/2017 0.00 $28.16 9/1/2019
1
MEDICAL
SERVICES 97124 AT UB 0 20 Years 0.00 $0.0000 $24.78 9/1/2019 0.00 $24.78 P2 0.00 $0.0000 $22.53 9/1/2019 0.00 $22.53 9/1/2019
1
MEDICAL
SERVICES 97124 AT UB 21 999 Years 0.00 $0.0000 $22.53 9/1/2019 0.00 $22.53 0.00 $0.0000 $22.53 9/1/2019 0.00 $22.53 9/1/2019
1
MEDICAL
SERVICES 97124 U5 0 20 Years 0.00 $0.0000 $30.98 9/1/2019 0.00 $30.98 P2 9/1/2019
1
MEDICAL
SERVICES 97124 U5 0 20 Years 0.00 $0.0000 $28.16 9/1/2017 0.00 $28.16 0.00 $0.0000 $28.16 9/1/2017 0.00 $28.16 9/1/2019
1
MEDICAL
SERVICES 97124 U5 21 999 Years 0.00 $0.0000 $28.16 9/1/2017 0.00 $28.16 0.00 $0.0000 $28.16 9/1/2017 0.00 $28.16 9/1/2019
1
MEDICAL
SERVICES 97124 UB 0 20 Years 0.00 $0.0000 $22.53 9/1/2019 0.00 $22.53 0.00 $0.0000 $22.53 9/1/2019 0.00 $22.53 9/1/2019
1
MEDICAL
SERVICES 97124 UB 0 20 Years 0.00 $0.0000 $24.78 9/1/2019 0.00 $24.78 P2 9/1/2019
1
MEDICAL
SERVICES 97124 UB 21 999 Years 0.00 $0.0000 $22.53 9/1/2019 0.00 $22.53 0.00 $0.0000 $22.53 9/1/2019 0.00 $22.53 9/1/2019
C
HOME HEALTH
PROCEDURE 97124 U5 0 20 Years 0.00 $0.0000 $30.98 9/1/2019 0.00 $30.98 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97124 U5 0 20 Years 0.00 $0.0000 $28.16 9/1/2017 0.00 $28.16 9/1/2019
C
HOME HEALTH
PROCEDURE 97124 U5 21 999 Years 0.00 $0.0000 $28.16 9/1/2017 0.00 $28.16 9/1/2019
C
HOME HEALTH
PROCEDURE 97124 UB 0 20 Years 0.00 $0.0000 $24.78 9/1/2019 0.00 $24.78 P2 0.00 $0.0000 $22.53 9/1/2019 0.00 $22.53 9/1/2019
C
HOME HEALTH
PROCEDURE 97124 UB 21 999 Years 0.00 $0.0000 $22.53 9/1/2019 0.00 $22.53 9/1/2019
1
MEDICAL
SERVICES 97140 AT U5 0 20 Years 0.00 $0.0000 $34.98 9/1/2019 0.00 $34.98 P2 9/1/2019
1
MEDICAL
SERVICES 97140 AT U5 0 20 Years 0.00 $0.0000 $31.80 9/1/2017 0.00 $31.80 9/1/2019
1
MEDICAL
SERVICES 97140 AT U5 21 999 Years 0.00 $0.0000 $31.80 9/1/2017 0.00 $31.80 0.00 $0.0000 $31.80 9/1/2017 0.00 $31.80 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 14 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
1
MEDICAL
SERVICES 97140 AT UB 0 20 Years 0.00 $0.0000 $27.98 9/1/2019 0.00 $27.98 P2 0.00 $0.0000 $25.44 9/1/2019 0.00 $25.44 9/1/2019
1
MEDICAL
SERVICES 97140 AT UB 21 999 Years 0.00 $0.0000 $25.44 9/1/2019 0.00 $25.44 0.00 $0.0000 $25.44 9/1/2019 0.00 $25.44 9/1/2019
1
MEDICAL
SERVICES 97140 U5 0 20 Years 0.00 $0.0000 $34.98 9/1/2019 0.00 $34.98 P2 9/1/2019
1
MEDICAL
SERVICES 97140 U5 0 20 Years 0.00 $0.0000 $31.80 9/1/2017 0.00 $31.80 0.00 $0.0000 $31.80 9/1/2017 0.00 $31.80 9/1/2019
1
MEDICAL
SERVICES 97140 U5 21 999 Years 0.00 $0.0000 $31.80 9/1/2017 0.00 $31.80 0.00 $0.0000 $31.80 9/1/2017 0.00 $31.80 9/1/2019
1
MEDICAL
SERVICES 97140 UB 0 20 Years 0.00 $0.0000 $25.44 9/1/2019 0.00 $25.44 0.00 $0.0000 $25.44 9/1/2019 0.00 $25.44 9/1/2019
1
MEDICAL
SERVICES 97140 UB 0 20 Years 0.00 $0.0000 $27.98 9/1/2019 0.00 $27.98 P2 9/1/2019
1
MEDICAL
SERVICES 97140 UB 21 999 Years 0.00 $0.0000 $25.44 9/1/2019 0.00 $25.44 0.00 $0.0000 $25.44 9/1/2019 0.00 $25.44 9/1/2019
C
HOME HEALTH
PROCEDURE 97140 U5 0 20 Years 0.00 $0.0000 $34.98 9/1/2019 0.00 $34.98 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97140 U5 0 20 Years 0.00 $0.0000 $31.80 9/1/2017 0.00 $31.80 9/1/2019
C
HOME HEALTH
PROCEDURE 97140 U5 21 999 Years 0.00 $0.0000 $31.80 9/1/2017 0.00 $31.80 9/1/2019
C
HOME HEALTH
PROCEDURE 97140 UB 0 20 Years 0.00 $0.0000 $27.98 9/1/2019 0.00 $27.98 P2 0.00 $0.0000 $25.44 9/1/2019 0.00 $25.44 9/1/2019
C
HOME HEALTH
PROCEDURE 97140 UB 21 999 Years 0.00 $0.0000 $25.44 9/1/2019 0.00 $25.44 9/1/2019
1
MEDICAL
SERVICES 97150 AT U5 0 20 Years 0.00 $0.0000 $37.74 9/1/2019 0.00 $37.74 P2 9/1/2019
1
MEDICAL
SERVICES 97150 AT U5 0 20 Years 0.00 $0.0000 $34.31 9/1/2017 0.00 $34.31 9/1/2019
1
MEDICAL
SERVICES 97150 AT U5 21 999 Years 0.00 $0.0000 $34.31 9/1/2017 0.00 $34.31 0.00 $0.0000 $34.31 9/1/2017 0.00 $34.31 9/1/2019
1
MEDICAL
SERVICES 97150 AT UB 0 20 Years 0.00 $0.0000 $30.19 9/1/2019 0.00 $30.19 P2 0.00 $0.0000 $27.45 9/1/2019 0.00 $27.45 9/1/2019
1
MEDICAL
SERVICES 97150 AT UB 21 999 Years 0.00 $0.0000 $27.45 9/1/2019 0.00 $27.45 0.00 $0.0000 $27.45 9/1/2019 0.00 $27.45 9/1/2019
1
MEDICAL
SERVICES 97150 U5 0 20 Years 0.00 $0.0000 $37.74 9/1/2019 0.00 $37.74 P2 9/1/2019
1
MEDICAL
SERVICES 97150 U5 0 20 Years 0.00 $0.0000 $34.31 9/1/2017 0.00 $34.31 0.00 $0.0000 $34.31 9/1/2017 0.00 $34.31 9/1/2019
1
MEDICAL
SERVICES 97150 U5 21 999 Years 0.00 $0.0000 $34.31 9/1/2017 0.00 $34.31 0.00 $0.0000 $34.31 9/1/2017 0.00 $34.31 9/1/2019
1
MEDICAL
SERVICES 97150 UB 0 20 Years 0.00 $0.0000 $27.45 9/1/2019 0.00 $27.45 0.00 $0.0000 $27.45 9/1/2019 0.00 $27.45 9/1/2019
1
MEDICAL
SERVICES 97150 UB 0 20 Years 0.00 $0.0000 $30.19 9/1/2019 0.00 $30.19 P2 9/1/2019
1
MEDICAL
SERVICES 97150 UB 21 999 Years 0.00 $0.0000 $27.45 9/1/2019 0.00 $27.45 0.00 $0.0000 $27.45 9/1/2019 0.00 $27.45 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 15 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
C
HOME HEALTH
PROCEDURE 97150 U5 0 20 Years 0.00 $0.0000 $37.74 9/1/2019 0.00 $37.74 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97150 U5 0 20 Years 0.00 $0.0000 $34.31 9/1/2017 0.00 $34.31 9/1/2019
C
HOME HEALTH
PROCEDURE 97150 U5 21 999 Years 0.00 $0.0000 $34.31 9/1/2017 0.00 $34.31 9/1/2019
C
HOME HEALTH
PROCEDURE 97150 UB 0 20 Years 0.00 $0.0000 $30.19 9/1/2019 0.00 $30.19 P2 0.00 $0.0000 $27.45 9/1/2019 0.00 $27.45 9/1/2019
C
HOME HEALTH
PROCEDURE 97150 UB 21 999 Years 0.00 $0.0000 $27.45 9/1/2019 0.00 $27.45 9/1/2019
1
MEDICAL
SERVICES 97161 0 20 Years 0.00 $0.0000 $127.81 9/1/2019 0.00 $127.81 P2 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97161 0 20 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97161 21 999 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97161 AT 0 20 Years 0.00 $0.0000 $127.81 9/1/2019 0.00 $127.81 P2 9/1/2019
1
MEDICAL
SERVICES 97161 AT 0 20 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97161 AT 21 999 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
C
HOME HEALTH
PROCEDURE 97161 0 20 Years 0.00 $0.0000 $127.81 9/1/2019 0.00 $127.81 P2 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
C
HOME HEALTH
PROCEDURE 97161 21 999 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97162 0 20 Years 0.00 $0.0000 $127.81 9/1/2019 0.00 $127.81 P2 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97162 0 20 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97162 21 999 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97162 AT 0 20 Years 0.00 $0.0000 $127.81 9/1/2019 0.00 $127.81 P2 9/1/2019
1
MEDICAL
SERVICES 97162 AT 0 20 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97162 AT 21 999 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
C
HOME HEALTH
PROCEDURE 97162 0 20 Years 0.00 $0.0000 $127.81 9/1/2019 0.00 $127.81 P2 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
C
HOME HEALTH
PROCEDURE 97162 21 999 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97163 0 20 Years 0.00 $0.0000 $127.81 9/1/2019 0.00 $127.81 P2 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 16 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
1
MEDICAL
SERVICES 97163 0 20 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97163 21 999 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97163 AT 0 20 Years 0.00 $0.0000 $127.81 9/1/2019 0.00 $127.81 P2 9/1/2019
1
MEDICAL
SERVICES 97163 AT 0 20 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97163 AT 21 999 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
C
HOME HEALTH
PROCEDURE 97163 0 20 Years 0.00 $0.0000 $127.81 9/1/2019 0.00 $127.81 P2 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
C
HOME HEALTH
PROCEDURE 97163 21 999 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97164 0 20 Years 0.00 $0.0000 $115.03 9/1/2019 0.00 $115.03 P2 0.00 $0.0000 $104.57 9/1/2017 0.00 $104.57 9/1/2019
1
MEDICAL
SERVICES 97164 0 20 Years 0.00 $0.0000 $104.57 9/1/2017 0.00 $104.57 9/1/2019
1
MEDICAL
SERVICES 97164 21 999 Years 0.00 $0.0000 $104.57 9/1/2017 0.00 $104.57 0.00 $0.0000 $104.57 9/1/2017 0.00 $104.57 9/1/2019
1
MEDICAL
SERVICES 97164 AT 0 20 Years 0.00 $0.0000 $115.03 9/1/2019 0.00 $115.03 P2 9/1/2019
1
MEDICAL
SERVICES 97164 AT 0 20 Years 0.00 $0.0000 $104.57 9/1/2017 0.00 $104.57 9/1/2019
1
MEDICAL
SERVICES 97164 AT 21 999 Years 0.00 $0.0000 $104.57 9/1/2017 0.00 $104.57 0.00 $0.0000 $104.57 9/1/2017 0.00 $104.57 9/1/2019
C
HOME HEALTH
PROCEDURE 97164 0 20 Years 0.00 $0.0000 $115.03 9/1/2019 0.00 $115.03 P2 0.00 $0.0000 $104.57 9/1/2017 0.00 $104.57 9/1/2019
C
HOME HEALTH
PROCEDURE 97164 21 999 Years 0.00 $0.0000 $104.57 9/1/2017 0.00 $104.57 9/1/2019
1
MEDICAL
SERVICES 97165 0 20 Years 0.00 $0.0000 $127.81 9/1/2019 0.00 $127.81 P2 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97165 0 20 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97165 21 999 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97165 AT 0 20 Years 0.00 $0.0000 $127.81 9/1/2019 0.00 $127.81 P2 9/1/2019
1
MEDICAL
SERVICES 97165 AT 0 20 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97165 AT 21 999 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
C
HOME HEALTH
PROCEDURE 97165 0 20 Years 0.00 $0.0000 $127.81 9/1/2019 0.00 $127.81 P2 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
C
HOME HEALTH
PROCEDURE 97165 21 999 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 17 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
1
MEDICAL
SERVICES 97166 0 20 Years 0.00 $0.0000 $127.81 9/1/2019 0.00 $127.81 P2 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97166 0 20 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97166 21 999 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97166 AT 0 20 Years 0.00 $0.0000 $127.81 9/1/2019 0.00 $127.81 P2 9/1/2019
1
MEDICAL
SERVICES 97166 AT 0 20 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97166 AT 21 999 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
C
HOME HEALTH
PROCEDURE 97166 0 20 Years 0.00 $0.0000 $127.81 9/1/2019 0.00 $127.81 P2 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
C
HOME HEALTH
PROCEDURE 97166 21 999 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97167 0 20 Years 0.00 $0.0000 $127.81 9/1/2019 0.00 $127.81 P2 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97167 0 20 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97167 21 999 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97167 AT 0 20 Years 0.00 $0.0000 $127.81 9/1/2019 0.00 $127.81 P2 9/1/2019
1
MEDICAL
SERVICES 97167 AT 0 20 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97167 AT 21 999 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
C
HOME HEALTH
PROCEDURE 97167 0 20 Years 0.00 $0.0000 $127.81 9/1/2019 0.00 $127.81 P2 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
C
HOME HEALTH
PROCEDURE 97167 21 999 Years 0.00 $0.0000 $116.19 9/1/2017 0.00 $116.19 9/1/2019
1
MEDICAL
SERVICES 97168 0 20 Years 0.00 $0.0000 $115.03 9/1/2019 0.00 $115.03 P2 0.00 $0.0000 $104.57 9/1/2017 0.00 $104.57 9/1/2019
1
MEDICAL
SERVICES 97168 0 20 Years 0.00 $0.0000 $104.57 9/1/2017 0.00 $104.57 9/1/2019
1
MEDICAL
SERVICES 97168 21 999 Years 0.00 $0.0000 $104.57 9/1/2017 0.00 $104.57 0.00 $0.0000 $104.57 9/1/2017 0.00 $104.57 9/1/2019
1
MEDICAL
SERVICES 97168 AT 0 20 Years 0.00 $0.0000 $115.03 9/1/2019 0.00 $115.03 P2 9/1/2019
1
MEDICAL
SERVICES 97168 AT 0 20 Years 0.00 $0.0000 $104.57 9/1/2017 0.00 $104.57 9/1/2019
1
MEDICAL
SERVICES 97168 AT 21 999 Years 0.00 $0.0000 $104.57 9/1/2017 0.00 $104.57 0.00 $0.0000 $104.57 9/1/2017 0.00 $104.57 9/1/2019
C
HOME HEALTH
PROCEDURE 97168 0 20 Years 0.00 $0.0000 $115.03 9/1/2019 0.00 $115.03 P2 0.00 $0.0000 $104.57 9/1/2017 0.00 $104.57 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 18 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
C
HOME HEALTH
PROCEDURE 97168 21 999 Years 0.00 $0.0000 $104.57 9/1/2017 0.00 $104.57 9/1/2019
1
MEDICAL
SERVICES 97530 AT U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
1
MEDICAL
SERVICES 97530 AT U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97530 AT U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97530 AT UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97530 AT UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97530 U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
1
MEDICAL
SERVICES 97530 U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97530 U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97530 UB 0 20 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97530 UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 9/1/2019
1
MEDICAL
SERVICES 97530 UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
C
HOME HEALTH
PROCEDURE 97530 U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97530 U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
C
HOME HEALTH
PROCEDURE 97530 U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
C
HOME HEALTH
PROCEDURE 97530 UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
C
HOME HEALTH
PROCEDURE 97530 UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97535 AT U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
1
MEDICAL
SERVICES 97535 AT U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97535 AT U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97535 AT UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97535 AT UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97535 U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 19 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
1
MEDICAL
SERVICES 97535 U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97535 U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97535 UB 0 20 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97535 UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 9/1/2019
1
MEDICAL
SERVICES 97535 UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
C
HOME HEALTH
PROCEDURE 97535 U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97535 U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
C
HOME HEALTH
PROCEDURE 97535 U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
C
HOME HEALTH
PROCEDURE 97535 UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
C
HOME HEALTH
PROCEDURE 97535 UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97537 AT U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
1
MEDICAL
SERVICES 97537 AT U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97537 AT U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97537 AT UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97537 AT UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97537 U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
1
MEDICAL
SERVICES 97537 U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97537 U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97537 UB 0 20 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97537 UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 9/1/2019
1
MEDICAL
SERVICES 97537 UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
C
HOME HEALTH
PROCEDURE 97537 U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97537 U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 20 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
C
HOME HEALTH
PROCEDURE 97537 U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
C
HOME HEALTH
PROCEDURE 97537 UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
C
HOME HEALTH
PROCEDURE 97537 UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97542 AT U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
1
MEDICAL
SERVICES 97542 AT U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97542 AT U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97542 AT UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97542 AT UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97542 U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
1
MEDICAL
SERVICES 97542 U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97542 U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97542 U5 UC 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97542 U5 UC 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97542 UB 0 20 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97542 UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 9/1/2019
1
MEDICAL
SERVICES 97542 UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97542 UB UC 0 20 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97542 UB UC 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
C
HOME HEALTH
PROCEDURE 97542 U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97542 U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
C
HOME HEALTH
PROCEDURE 97542 U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
C
HOME HEALTH
PROCEDURE 97542 UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 21 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
C
HOME HEALTH
PROCEDURE 97542 UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97750 U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
1
MEDICAL
SERVICES 97750 U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97750 U5 21 999 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97750 UB 0 20 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97750 UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 9/1/2019
1
MEDICAL
SERVICES 97750 UB 21 999 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97760 U5 0 20 Years 0.00 $0.0000 $38.07 9/1/2019 0.00 $38.07 P2 9/1/2019
1
MEDICAL
SERVICES 97760 U5 0 20 Years 0.00 $0.0000 $34.61 9/1/2017 0.00 $34.61 0.00 $0.0000 $34.61 9/1/2017 0.00 $34.61 9/1/2019
1
MEDICAL
SERVICES 97760 UB 0 20 Years 0.00 $0.0000 $27.69 9/1/2019 0.00 $27.69 0.00 $0.0000 $27.69 9/1/2019 0.00 $27.69 9/1/2019
1
MEDICAL
SERVICES 97760 UB 0 20 Years 0.00 $0.0000 $30.46 9/1/2019 0.00 $30.46 P2 9/1/2019
1
MEDICAL
SERVICES 97761 U5 0 20 Years 0.00 $0.0000 $37.13 9/1/2019 0.00 $37.13 P2 9/1/2019
1
MEDICAL
SERVICES 97761 U5 0 20 Years 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 0.00 $0.0000 $33.75 9/1/2017 0.00 $33.75 9/1/2019
1
MEDICAL
SERVICES 97761 UB 0 20 Years 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 0.00 $0.0000 $27.00 9/1/2019 0.00 $27.00 9/1/2019
1
MEDICAL
SERVICES 97761 UB 0 20 Years 0.00 $0.0000 $29.70 9/1/2019 0.00 $29.70 P2 9/1/2019
1
MEDICAL
SERVICES 97763 U5 0 20 Years 0.00 $0.0000 $39.23 9/1/2019 0.00 $39.23 P2 9/1/2019
1
MEDICAL
SERVICES 97763 U5 0 20 Years 0.00 $0.0000 $35.66 1/1/2018 0.00 $35.66 0.00 $0.0000 $35.66 1/1/2018 0.00 $35.66 9/1/2019
1
MEDICAL
SERVICES 97763 UB 0 20 Years 0.00 $0.0000 $28.53 9/1/2019 0.00 $28.53 0.00 $0.0000 $28.53 9/1/2019 0.00 $28.53 9/1/2019
1
MEDICAL
SERVICES 97763 UB 0 20 Years 0.00 $0.0000 $31.38 9/1/2019 0.00 $31.38 P2 9/1/2019
1
MEDICAL
SERVICES 97799 AT U5 0 20 Years 0.00 $0.0000 $39.38 9/1/2019 0.00 $39.38 P2 9/1/2019
1
MEDICAL
SERVICES 97799 AT U5 0 20 Years 0.00 $0.0000 $35.80 9/1/2017 0.00 $35.80 9/1/2019
1
MEDICAL
SERVICES 97799 AT U5 21 999 Years 0.00 $0.0000 $35.80 9/1/2017 0.00 $35.80 0.00 $0.0000 $35.80 9/1/2017 0.00 $35.80 9/1/2019
1
MEDICAL
SERVICES 97799 AT UB 0 20 Years 0.00 $0.0000 $31.50 9/1/2019 0.00 $31.50 P2 0.00 $0.0000 $28.64 9/1/2019 0.00 $28.64 9/1/2019
1
MEDICAL
SERVICES 97799 AT UB 21 999 Years 0.00 $0.0000 $28.64 9/1/2019 0.00 $28.64 0.00 $0.0000 $28.64 9/1/2019 0.00 $28.64 9/1/2019
1
MEDICAL
SERVICES 97799 U5 0 20 Years 0.00 $0.0000 $39.38 9/1/2019 0.00 $39.38 P2 9/1/2019
1
MEDICAL
SERVICES 97799 U5 0 20 Years 0.00 $0.0000 $35.80 9/1/2017 0.00 $35.80 0.00 $0.0000 $35.80 9/1/2017 0.00 $35.80 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 22 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
1
MEDICAL
SERVICES 97799 U5 21 999 Years 0.00 $0.0000 $35.80 9/1/2017 0.00 $35.80 0.00 $0.0000 $35.80 9/1/2017 0.00 $35.80 9/1/2019
1
MEDICAL
SERVICES 97799 UB 0 20 Years 0.00 $0.0000 $28.64 9/1/2019 0.00 $28.64 0.00 $0.0000 $28.64 9/1/2019 0.00 $28.64 9/1/2019
1
MEDICAL
SERVICES 97799 UB 0 20 Years 0.00 $0.0000 $31.50 9/1/2019 0.00 $31.50 P2 9/1/2019
1
MEDICAL
SERVICES 97799 UB 21 999 Years 0.00 $0.0000 $28.64 9/1/2019 0.00 $28.64 0.00 $0.0000 $28.64 9/1/2019 0.00 $28.64 9/1/2019
C
HOME HEALTH
PROCEDURE 97799 U5 0 20 Years 0.00 $0.0000 $39.38 9/1/2019 0.00 $39.38 P2 9/1/2019
C
HOME HEALTH
PROCEDURE 97799 U5 0 20 Years 0.00 $0.0000 $35.80 9/1/2017 0.00 $35.80 9/1/2019
C
HOME HEALTH
PROCEDURE 97799 U5 21 999 Years 0.00 $0.0000 $35.80 9/1/2017 0.00 $35.80 9/1/2019
C
HOME HEALTH
PROCEDURE 97799 UB 0 20 Years 0.00 $0.0000 $31.50 9/1/2019 0.00 $31.50 P2 0.00 $0.0000 $28.64 9/1/2019 0.00 $28.64 9/1/2019
C
HOME HEALTH
PROCEDURE 97799 UB 21 999 Years 0.00 $0.0000 $28.64 9/1/2019 0.00 $28.64 9/1/2019
1
MEDICAL
SERVICES 98960 0 20 Years 0.77 $28.0672 $21.61 7/1/2019 0.00 $21.61 0.77 $28.0672 $21.61 7/1/2019 0.00 $21.61 7/1/2019
1
MEDICAL
SERVICES 99503 0 20 Years 0.00 $0.0000 $39.92 10/1/2016 0.00 $39.92 6 0.00 $0.0000 $39.92 10/1/2016 0.00 $39.92 6 10/1/2018
C
HOME HEALTH
PROCEDURE G0156 0 999 Years 0.00 $0.0000 $46.09 11/1/2015 0.00 $46.09 1/1/2018
1
MEDICAL
SERVICES G0162 0 999 Years 0.00 $0.0000 $11.05 9/1/2015 0.00 $11.05 1/1/2018
1
MEDICAL
SERVICES G0162 U1 0 999 Years 0.00 $0.0000 $11.05 9/1/2015 0.00 $11.05 1/1/2018
C
HOME HEALTH
PROCEDURE G0299 0 999 Years 0.00 $0.0000 $98.92 1/1/2018 0.00 $98.92 1/1/2018
C
HOME HEALTH
PROCEDURE G0300 0 999 Years 0.00 $0.0000 $98.92 1/1/2018 0.00 $98.92 1/1/2018
1
MEDICAL
SERVICES S9110 U1 0 999 Years 0.00 $0.0000 $50.00 1/1/2019 0.00 $50.00 1/1/2019
1
MEDICAL
SERVICES S9110 U2 0 999 Years 0.00 $0.0000 $47.25 1/1/2019 0.00 $47.25 1/1/2019
1
MEDICAL
SERVICES S9110 U3 0 999 Years 0.00 $0.0000 $94.50 1/1/2019 0.00 $94.50 1/1/2019
1
MEDICAL
SERVICES S9110 U4 0 999 Years 0.00 $0.0000 $141.75 1/1/2019 0.00 $141.75 1/1/2019
1
MEDICAL
SERVICES S9110 U7 0 999 Years 0.00 $0.0000 $189.00 1/1/2019 0.00 $189.00 1/1/2019
1
MEDICAL
SERVICES S9110 U8 0 999 Years 0.00 $0.0000 $236.25 1/1/2019 0.00 $236.25 1/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 Page 23 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
1 2 3 1 2 3
Change
Ind
Client Age Facility
Note Codes
Non-facility
Note Codes
Frm Thru Units
Total
RVUs/
Base
Units
Conversion
Factor
Adjusted
Fee for
Report
Date
Medicaid
Fee
Fee Effect
Date
Adjust
%
Adjusted
Fee for
Report
Date
Total
RVUs/
Base
Units
Conversion
Factor
Medicaid
Fee
Fee Effect
Date
Adjust
%
TOS TOS DescProc
Code
Last Pricing
Review
Date
Mod
1
Mod
2
1
MEDICAL
SERVICES S9110 U9 0 999 Years 0.00 $0.0000 $283.50 1/1/2019 0.00 $283.50 1/1/2019
1
MEDICAL
SERVICES S9152 0 20 Years 0.00 $0.0000 $130.76 9/1/2019 0.00 $130.76 P2 0.00 $0.0000 $118.87 9/1/2017 0.00 $118.87 9/1/2019
1
MEDICAL
SERVICES S9152 0 20 Years 0.00 $0.0000 $118.87 9/1/2017 0.00 $118.87 9/1/2019
1
MEDICAL
SERVICES S9152 21 999 Years 0.00 $0.0000 $118.87 9/1/2017 0.00 $118.87 0.00 $0.0000 $118.87 9/1/2017 0.00 $118.87 9/1/2019
1
MEDICAL
SERVICES S9441 0 20 Years 0.00 $0.0000 $21.12 4/1/2019 0.00 $21.12 0.00 $0.0000 $21.12 4/1/2019 0.00 $21.12 4/1/2019
C
HOME HEALTH
PROCEDURE T1000 TD 0 20 Years 0.00 $0.0000 $11.33 9/1/2019 0.00 $11.33 6 9/1/2019
C
HOME HEALTH
PROCEDURE T1000 TD UA 0 20 Years 0.00 $0.0000 $13.03 9/1/2019 0.00 $13.03 6 9/1/2019
C
HOME HEALTH
PROCEDURE T1000 TE 0 20 Years 0.00 $0.0000 $8.29 9/1/2019 0.00 $8.29 6 9/1/2019
C
HOME HEALTH
PROCEDURE T1000 TE UA 0 20 Years 0.00 $0.0000 $9.09 9/1/2019 0.00 $9.09 6 9/1/2019
1
MEDICAL
SERVICES T1019 U6 0 20 Years 0.00 $0.0000 $2.95 9/1/2015 0.00 $2.95 9/1/2019
1
MEDICAL
SERVICES T1019 U7 0 20 Years 0.00 $0.0000 $2.75 9/1/2015 0.00 $2.75 9/1/2019
1
MEDICAL
SERVICES T1019 U9 0 20 Years 0.00 $0.0000 $3.46 6/1/2015 0.00 $3.46 9/1/2019
1
MEDICAL
SERVICES T1019 UA 0 20 Years 0.00 $0.0000 $3.46 9/1/2011 0.00 $3.46 9/1/2019
1
MEDICAL
SERVICES T1019 UB 0 20 Years 0.00 $0.0000 $3.26 9/1/2011 0.00 $3.26 9/1/2019
1
MEDICAL
SERVICES T1019 UD 0 20 Years 0.00 $0.0000 $2.95 9/1/2015 0.00 $2.95 9/1/2019
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
3/13/2020 24 of 24TEXAS MEDICAID FEE SCHEDULE -
HOME HEALTH AGENCY
Note Code(s): 6 - This procedure is payable only through the CCP program.
P2 - Displayed fee reflects reimbursement for the service rendered in the home setting.
Due to AMA/ADA copyright restrictions, CPT and CDT procedure code and modifier descriptions cannot be published in this document.
